Season 1
A pediatrics episode on headache in children and adolescents, built on the Cribsiders episode with pediatric neurologist John Gaitanis and updated with two things that changed after it aired. The first is the August 2025 FDA approval of fremanezumab for episodic migraine down to age six, which makes a CGRP monoclonal antibody a pediatric option for the first time; the second is the March 2025 labeling change across the whole CGRP class for hypertension and Raynaud phenomenon. The episode covers how to take a headache history from a child who cannot give you one, the red flags that actually earn imaging and the far longer list that does not, why pediatric migraine looks different from adult migraine in the diagnostic criteria themselves, the CHAMP trial and its enormous placebo response, the acute and preventive drug options with doses, and the documented diagnostic disparity by race. It closes on the combined oral contraceptive and migraine-with-aura question, where the American and European guidance disagree.
I cannot remove this autotext; do not send me a voice note. Largely drawn from Penn Primary Care's recent two-part series
This week's sweep covers six items from the September Annals of Internal Medicine. It opens with EMPOWER, a randomized trial finding that adding CBT or peer-led self-management to a patient-centered opioid taper didn't improve success, though roughly half of patients halved their dose with a well-supported taper alone. Two obesity pieces follow — the ACP's living review of weight-loss drugs and the updated VA/DoD guideline — which converge on treating obesity as a chronic condition and not stopping effective medication. Two ACP Journal Club items show benefits that look better in the headline than the detail: a digoxin meta-analysis where fewer heart failure events carry the whole effect while cardiovascular death doesn't budge, and TAPIS, where early dual antiplatelet therapy after stroke thrombolysis improved function in a population too narrow to generalize. It closes with practical guidance on protecting immigrant patients, from documentation and health care proxies to rights in custody.
Reviewing highlights of the week to keep it in your brain gooder
REVISED 5 October 2026, after reading the full guideline text and its two published corrections: adds the percent-reduction goals, settles the triglyceride thresholds (apoB testing at 150 after a June correction; risk enhancer 175 nonfasting or 150 fasting), refines the very-high-risk tier, and notes that ezetimibe is no longer required before a PCSK9 antibody in clinical ASCVD. Earlier revision 30 September 2026. An approach episode on lipoprotein(a), apolipoprotein B, and the 2026 ACC/AHA dyslipidemia guideline, drawing on an ACP meeting session that applied the guideline a month after publication. It covers the cholesterol-years argument for treating earlier, the switch to the PREVENT risk calculator and why its lower numbers require recalibrated thresholds, new screening ages, and measuring lipoprotein(a) once in every adult. Numeric LDL targets are back, including below fifty-five for very high risk. Also covered: when apolipoprotein B adds information, the role of coronary calcium scoring, the SAMSON trial showing most statin intolerance is nocebo, and a mismatch between the evidence for bempedoic acid and how the guideline recommends it. This revision does two things the original did not: it reports the failure of pelacarsen in the Lp(a)HORIZON trial, announced on 4 September, which falsified the original episode's suggestion that a targeted lipoprotein(a) therapy was close; and it adds the reproductive risk-enhancing factors — menopause before forty-five, preeclampsia, gestational diabetes, gestational hypertension, preterm delivery — which the original omitted. 2026 ACC/AHA DYSLIPIDEMIA GUIDELINE — QUICK REFERENCE Goals: % LDL reduction AND absolute goal (LDL / non-HDL / apoB, mg/dL) Primary prevention (PREVENT 10-yr ASCVD risk) - Low (<3%): lifestyle; no goal - Borderline (3 to <5%): 30-49% | <100 / <130 / <90 - Intermediate (5 to <10%): 30-49%, >=50% at upper end | <100 / <130 / <90 - High (>=10%): >=50% | <70 / <100 / <70 Diabetes, age 40-75 - Standard: 30-49% | <100 / <130 - Multiple risk factors: >=50% | <70 / <100 Coronary calcium - CAC 1-99: 30-49% | <100 / <130 - CAC 100-999: >=50% | <70 / <100 (300-999: optional <55) - CAC >=1000: >=50% | <55 / <85 LDL >=190: absolute goals only (<100, or <70 with HeFH/risk factors/CAC, <55 with ASCVD) Clinical ASCVD - Not very high risk: >=50% | <70 / <100 (optional <55) - Very high risk: >=50% | <55 / <85 / <55 (multiple major events, or 1 major event + multiple high-risk conditions) Other thresholds - TG risk enhancer: persistently >=175 nonfasting or >=150 fasting - Check apoB once LDL/non-HDL goals met if TG >=150 (June 2026 correction; was >200) - Lp(a) risk enhancer: >=125 nmol/L (>=50 mg/dL); measure once in all adults - Clinical ASCVD: ezetimibe no longer required before a PCSK9 antibody; pick by LDL gap - ApoB tier goals are from the guideline's Figure 1 (not verified against text)
Growth Faltering (previously "failure to thrive") in children, updated 09/17/2026
Fibromyalgia review w/Dr. Clauw
Broad review of recent medical publications
Reviews the week
Obstructive Sleep Apnea